Sen. Susan Collins deals potential lethal blow to GOP health care bill

WASHINGTON — The GOP's last-ditch effort to repeal and replace Obamacare received what appeared to be a fatal blow Monday evening when Sen. Susan Collins, R-Maine, announced her decision not to support the bill, becoming the crucial third Republican to oppose it.

Collins joins Sens. John McCain, R-Ariz., and Rand Paul, R-Ky., as GOP "no" votes. Unless one of them switches their position, Republicans can't muster the 50 votes needed to pass it.

The bill entered the day hanging by a thread even after a new version of the billwas released Monday that tries to appease the concerns of a handful of uncommitted Republican senators.

GOP leaders faced a Saturday deadline to pass the bill with a simple Senate majority and the Republican push took on renewed urgency Monday.

The Senate Finance Committee held the first and only hearing Monday afternoon on legislation written by two Republicans, Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, in an attempt to soften the complaints of senators upset by the lack of vetting for a bill that would affect one-sixth of the nation’s economy.

Protestors filled the hallways outside the hearing room that snaked around the corner and down the length of a city block. Hundreds of people chanted "shame" as Graham entered the hearing room to testify before the committee. Voluminous protests inside the hearing room delayed the start of the hearing. Chairman Orrin Hatch, R-Utah, attempted to gavel in the committee but protestors drowned him out. Police dragged them out, many of whom are disabled and in wheelchairs, out one by one.

Once the committee room was clear of the public, the hearing began. Protestors maintained their chants in the hallway outside; their sound seeping through the doors providing constant background chanting.The Association of Health Insurance Plans and Blue Cross Blue Shield released prepared testimony before the hearing stating that they can't support Graham-Cassidy.

"The bill would have negative consequences on consumers and patients by further destabilizing the individual market; cutting Medicaid; pulling back on protections for pre-existing conditions; not ending taxes on health insurance premiums and benefits; and potentially allowing government-controlled, single-payer health care to grow," a summary of their testimony states.

Graham testified that it was a “disaster” in his state and boasted that "every major insurance company opposes our bill,” saying it was evidence that his legislation would give states more flexibility in dealing with them.

But Democrats pointed out it wasn’t just insurers upset with Graham-Cassidy: The top industry groups representing doctors and hospitals also publicly opposed the bill along with a parade of patient advocacy groups, from AARP to the American Heart Association. These organizations have argued the bill would cut overall health funding while allowing insurers to treat customers differently based on a pre-existing condition, a practice banned by Obamacare.

Under questioning from Senator Ron Wyden, D-Ore., Cassidy said their assessments were wrong and that it was “not true” that states could charge higher premiums based on their health status under his bill.

But the bill as written allows states to waive Obamacare’s rule preventing insurers from charging sick people more for care as well as its requirements that plans cover certain essential benefits. Outside analysts have consistently said it would weaken protections for pre-existing conditions.

"It doesn’t protect them, Senator,” Dick Woodruff, the VP of the American Cancer Society Action Network told Wyden when asked whether cancer patients would be affected by these changes.

After working through the weekend to shore up votes, Graham and Cassidy released a new version Monday to appeal to a handful of holdouts. It included additional money for Alaska, Maine, Arizona and Kentucky for the four biggest critics in the Senate. In particular, it carved out special funding protections for Alaska to help the state reign in the high cost of health care, and it loosened the regulations on insurance coverage to help conservatives come on board.

An analysis of state-by-state health care funding shows that under Graham-Cassidy, Alaska would get 4 percent more funding than under current heath care levels to implement a health care system. It would still lose money, however, from an end to the Medicaid expansion. The state estimates that it would lose $100 million.

Other states with critical senators receive additional funds as well. Maine would see a 43 percent increase in federal health care funds, Arizona would get an additional 14 percent and Kentucky another 4 percent. But critics say even those numbers are misleading because the figures don't account for the loss of money from ending the Medicaid expansion, something that applies to all three.

Activists descended on Capitol Hill on Monday to protest the measure. The line outside the hearing room began forming at 6:00 a.m. and stretched more than a city block. Protestors sat-in the office of Murkowski in protest. Her chief-of-staff came out to address the activists and said that she left Anchorage at 6 a.m. on Monday and is using her flight time back to D.C. “thinking about her decision.”

Marilee Adanski-Smith traveled to D.C. from Wisconsin on Saturday to attend the hearing. She was born without arms and legs and relies on Medicaid.

“We’re here to save Medicaid. Our lives depend on Medicaid,” she said, adding that she’s fearful that the legislation will take away Medicaid recipients' ability to live at home and force people into nursing homes.

“People are going to die in nursing homes if people don’t have the community and home-based services they need,” Adanski-Smith, a small-business owner, added.

Graham-Cassidy would end the Medicaid expansion in 2020 and reduce the money given to Medicaid by changing how it's allocated. It would no longer provide it for whoever is in need — instead, it would cap the number based on population.

The bill would also end the individual mandate to buy insurance and dismantle the structure of the Affordable Care Act, widely known as Obamacare. Instead, it would give money to states to implement their own health care systems. And while it would require that people with pre-existing conditions have access to health insurance, like Obamacare, it wouldn't prohibit insurance companies from charging people with long-term health care needs more money.

The new version of Graham-Cassidy would also provide billions of dollars more for states during the transition from Obamacare and as a contingency fund.